Provider Demographics
NPI:1205412236
Name:ALDAG, DESIREE (CBHCMS, CAP, CTP)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ALDAG
Suffix:
Gender:F
Credentials:CBHCMS, CAP, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 LEGATTO LOOP
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4051
Mailing Address - Country:US
Mailing Address - Phone:407-508-4512
Mailing Address - Fax:
Practice Address - Street 1:4902 EISENHOWER BLVD STE 315
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6344
Practice Address - Country:US
Practice Address - Phone:813-786-7681
Practice Address - Fax:813-283-9110
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS.0102754171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator